Osteochondral Autograft Transplant (Mosaicplasty) Without Debriding the Recipient Site in Osteochondral Lesions of the Talus: Clinical Outcomes of a Prospective Study.

Abstract

Although mosaicplasty has been a preferred surgery for osteochondral lesions of the talus (OLT), debriding the recipient bed may create interplug voids in larger defects. We evaluated clinical and imaging outcomes of mosaicplasty performed without recipient-site debridement.MethodsBetween March 2017 and August 2023, consecutive patients of OLT who were candidates for mosaicplasty were included in the study. Baseline demographics were recorded, and functional outcomes, including the American Orthopaedic Foot & Ankle Society (AOFAS), visual analog scale (VAS), and Lysholm scores, were assessed pre- and postoperatively. Imaging assessments, including radiography, computed tomography, and magnetic resonance imaging (MRI), were performed preoperatively to evaluate lesions and at 6 months postoperative and at last follow-up to assess cartilage integrity in all patients. Intraoperative lesion location or size and plug number were recorded. Thirty-two patients (mean age 36 years) completed follow-up (mean 35.8 months). AOFAS improved from 59 ± 16 to 85 ± 13 and VAS from 6.0 ± 1.6 to 1.6 ± 1.3 (both <i>P</i> < .001). Eight patients (25%) required hardware removal; 2 reported persistent ankle pain; and 1 had a clinically relevant decline in donor-knee Lysholm. Preoperative osteoarthritis predicted lower odds of AOFAS >80. The integrity of the autograft plugs at the follow-up MRI was found to be good for all patients. Mosaicplasty, omitting recipient-site debridement, was associated with within-group functional improvement and MRI evidence of plug integrity. Findings should be interpreted cautiously, given the single-arm design, small sample size, and relatively short average follow-up of 3 years.